Provider Demographics
NPI:1639231418
Name:GUILLEN, JUAN ANTONIO (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:ANTONIO
Last Name:GUILLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 140177
Mailing Address - Street 2:
Mailing Address - City:ARCCIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614
Mailing Address - Country:US
Mailing Address - Phone:787-880-2662
Mailing Address - Fax:787-880-2662
Practice Address - Street 1:AVE BARBOSA #65 ESQ JOSE DE DIEGO
Practice Address - Street 2:ARCCIBO MEDICAL PLAZA #103
Practice Address - City:ARCCIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-880-2662
Practice Address - Fax:787-880-2662
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR45862084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
C79668Medicare UPIN
PR0027498Medicare ID - Type Unspecified